Response

The recent BJPsych article by Gkitakou and colleagues, ‘Anxiety and mood disorders on the rise: exploring clinical profiles and risk factors’, ^{Reference Gkitakou, Ten Have, Batelaan, Luik and Penninx1} examines trends in the 12-month prevalence of anxiety and mood disorders using data from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS). Their findings of increased prevalence, earlier onset and greater comorbidity resonate strongly with my clinical experience in adult secondary care.

In secondary care, patients rarely present with clearly delineated diagnoses. Anxiety and mood symptoms frequently overlap, evolve over time and are closely shaped by ongoing psychosocial stressors, such as social adversity or interpersonal difficulties. As a result, formulation and treatment planning can be more complex than diagnostic categories alone suggest. The longitudinal data presented by Gkitakou and colleagues help illustrate how these patterns have developed over more than a decade, rather than representing a short-term fluctuation.

At the same time, rising prevalence figures require cautious interpretation. Alongside any real increase in disorder, improved recognition, reduced stigma and greater willingness to seek help are likely contributors. In practice it is often difficult to distinguish between worsening population mental health and a system that is now more responsive to visible distress that previously went unrecognised or unsupported.

The findings also raise important questions for service delivery. Earlier onset and higher levels of comorbidity underline the need for integrated, psychologically informed approaches across primary and secondary care. Enhancing timely access to psychological interventions and addressing social determinants of mental health may be as important as diagnostic clarity for shaping longer-term outcomes and reducing repeated service use.

Overall, the paper by Gkitakou and colleagues provides a useful opportunity for clinicians to reflect on how mental health services might adapt to the changing nature of anxiety and mood disorders. It reinforces the importance of formulation-based thinking and service models capable of accommodating complexity, rather than relying solely on narrow diagnostic distinctions.